Skip to main content

Advertisement

SpringerLink
Log in

Triathlon training for women breast cancer survivors: feasibility and initial efficacy

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

ᅟ

Exercise can improve quality of life (QOL) in breast cancer survivors. In contrast to many group or home-based exercise programs, little is known about the effectiveness of goal-oriented recreational activities.

Purpose

The purpose of this study was to evaluate a clinically overseen team triathlon training program on improving physiological and psychosocial health-related measures in female breast cancer survivors.

Methods

Twenty-three participants (age = 48 (8), BMI = 25 (1), mean (SE)) were recruited from a 14-week sprint triathlon (800-m swim, 20-km bike, 5-km run) team training program for women breast cancer survivors (4 (3) years post-surgery, chemo-, or radiation-therapy). Training included two supervised group and three home-based individual sessions per week. Pre- and post-training outcomes included isokinetic knee extensor strength (60, 180, and 300° s−1), 6-min walk test (6MWT), maximal oxygen uptake (VO2 max), QOL (Functional Assessment of Cancer Therapy -Breast (FACT-B)), and barriers to exercise. Outcomes were also obtained 6 months post except for VO2 max. Significance was set at p < 0.05.

Results

Data are mean (SD) from 21 complete data sets. Knee extensor peak torque significantly improved only at 300° s−1 (pre 40.3(8.5) ftlb; post 45.2(8.4); p = 0.001). 6MWT significantly improved (pre 632.8(62.1) m; post 657.4(53.2); p = 0.014) as did VO2 max (pre 31.3(5.8) ml kg−1 min−1; post 35.9(5.8); p < 0.001). FACT-B also improved (pre 114(12); post 122(13); p = 0.004), including the FACT-G total score, social well-being, and breast cancer subscales while barriers to exercise decreased (pre 54(12); post 36(9); p < 0.001). Strength, 6MWT, and barriers to exercise remained improved after 6 months.

Conclusions

Team triathlon training in breast cancer survivors can increase aerobic capacity and improve QOL which may contribute to healthier lifestyles in breast cancer survivors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. American Cancer Society (2015) Cancer facts & figures 2015. American Cancer Society, Atlanta

    Google Scholar 

  2. American Cancer Society (2014) Cancer treatment and survivorship facts & figures 2014–2015. American Cancer Society, Atlanta

    Google Scholar 

  3. Aziz NM, Rowland JH (2003) Trends and advances in cancer survivorship research: challenge and opportunity. Semin Radiat Oncol 13(3):248–266. doi:10.1016/S1053-4296(03)00024-9

    Article  PubMed  Google Scholar 

  4. Jenkins J (2006) Survivorship: finding a new balance. Semin Oncol Nurs 22(2):117–125. doi:10.1016/j.soncn.2006.01.007

    Article  PubMed  Google Scholar 

  5. Hanrahan EO, Gonzalez-Angulo AM, Giordano SH, Rouzier R, Broglio KR, Hortobagyi GN, Valero V (2007) Overall survival and cause-specific mortality of patients with stage T1a,bN0M0 breast carcinoma. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 25(31):4952–4960. doi:10.1200/JCO.2006.08.0499

    Article  Google Scholar 

  6. Patnaik JL, Byers T, DiGuiseppi C, Dabelea D, Denberg TD (2011) Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Res 13(3):R64. doi:10.1186/bcr2901

    Article  PubMed  PubMed Central  Google Scholar 

  7. McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS (2006) Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 175(1):34–41. doi:10.1503/cmaj.051073

    Article  PubMed  Google Scholar 

  8. Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH (2010) An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Journal of cancer survivorship : research and practice 4(2):87–100. doi:10.1007/s11764-009-0110-5

    Article  Google Scholar 

  9. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz AL, American College of Sports M (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42(7):1409–1426. doi:10.1249/MSS.0b013e3181e0c112

    Article  PubMed  Google Scholar 

  10. Ballard-Barbash R, Friedenreich CM, Courneya KS, Siddiqi SM, McTiernan A, Alfano CM (2012) Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst 104(11):815–840. doi:10.1093/jnci/djs207

    Article  PubMed  PubMed Central  Google Scholar 

  11. Floyd A, Moyer A (2009) Group vs. individual exercise interventions for women with breast cancer: a meta-analysis. Health Psychology Review 4(1):22–41. doi:10.1080/17437190903384291

    Article  PubMed  PubMed Central  Google Scholar 

  12. Courneya KS, Blanchard CM, Laing DM (2001) Exercise adherence in breast cancer survivors training for a dragon boat race competition: a preliminary investigation. Psycho-Oncology 10(5):444–452

    Article  CAS  PubMed  Google Scholar 

  13. McKenzie DC (1998) Abreast in a boat—a race against breast cancer. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 159(4):376–378

    CAS  PubMed  Google Scholar 

  14. Parry DC (2008) The contribution of dragon boat racing to women’s health and breast cancer survivorship. Qual Health Res 18(2):222–233. doi:10.1177/1049732307312304

    Article  PubMed  Google Scholar 

  15. Unruh AM, Elvin N (2004) In the eye of the dragon: women’s experience of breast cancer and the occupation of dragon boat racing. Canadian Journal of Occupational Therapy Revue Canadienne d'Ergotherapie 71(3):138–149

    Article  PubMed  Google Scholar 

  16. USA Triathlon. (2014) USA triathlon annual membership hits record high in 2013. In: Demographics. http://www.usatriathlon.org/about-multisport/demographics/aspx.. Accessed 7/9/2015

  17. Triathlon U (2014) NCAA division I legislative council approves triathlon as emerging sport. http://www.usatriathlon.org/news/articles/2014/1/011614-ncaa-announcement.aspx. Accessed 10/17/2014

  18. Suriano R, Bishop D (2010) Physiological attributes of triathletes. Journal of science and medicine in sport / Sports Medicine Australia 13(3):340–347. doi:10.1016/j.jsams.2009.03.008

    Article  CAS  Google Scholar 

  19. Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, Harbour RT, Caldwell LM, Creed G (2011) Exercise for preventing and treating osteoporosis in postmenopausal women. The Cochrane Database of Systematic Reviews 7:CD000333. doi:10.1002/14651858.CD000333.pub2

    Google Scholar 

  20. Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR, American College of Sports M (2004) American College of Sports Medicine position stand: physical activity and bone health. Med Sci Sports Exerc 36(11):1985–1996

    Article  Google Scholar 

  21. Kohrt WM, Ehsani AA, Birge SJ Jr (1997) Effects of exercise involving predominantly either joint-reaction or ground-reaction forces on bone mineral density in older women. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 12(8):1253–1261. doi:10.1359/jbmr.1997.12.8.1253

    Article  CAS  Google Scholar 

  22. Snow-Harter C, Bouxsein ML, Lewis BT, Carter DR, Marcus R (1992) Effects of resistance and endurance exercise on bone mineral status of young women: a randomized exercise intervention trial. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 7(7):761–769. doi:10.1002/jbmr.5650070706

    Article  CAS  Google Scholar 

  23. Robinson KM, Piacentine LB, Waltke LJ, Ng AV, Tjoe JA (2016) Survivors speak: a qualitative analysis of motivational factors influencing breast cancer survivors’ participation in a sprint distance triathlon. J Clin Nurs 25(1–2):247–256. doi:10.1111/jocn.13067

    Article  PubMed  Google Scholar 

  24. American College of Sports Medicine (2014) ACSM’s guidelines for exercise testing and prescription, Ninth edn. Wolters Kluwer/Lippincott Williams & Wilkins Health, Philadelphia

    Google Scholar 

  25. Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, Deasy S, Cobleigh M, Shiomoto G (1997) Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol 15(3):974–986

    Article  CAS  PubMed  Google Scholar 

  26. Brucker PS, Yost K, Cashy J, Webster K, Cella D (2005) General population and cancer patient norms for the functional assessment of cancer therapy-general (FACT-G). Evaluation & the health professions 28(2):192–211. doi:10.1177/0163278705275341

    Article  Google Scholar 

  27. Rogers LQ, Markwell S, Hopkins-Price P, Vicari S, Courneya KS, Hoelzer K, Verhulst S (2011) Reduced barriers mediated physical activity maintenance among breast cancer survivors. Journal of Sport & Exercise Psychology 33(2):235–254

    Article  Google Scholar 

  28. Rogers LQ, McAuley E, Courneya KS, Verhulst SJ (2008) Correlates of physical activity self-efficacy among breast cancer survivors. Am J Health Behav 32(6):594–603. doi:10.5555/ajhb.2008.32.6.594

    Article  PubMed  Google Scholar 

  29. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. (2002) ATS statement: guidelines for the 6-min walk test. American Journal of Respiratory and Critical Care Medicine 166 (1):111–117. doi:10.1164/ajrccm.166.1.at1102

  30. Cella D, Hahn EA, Dineen K (2002) Meaningful change in cancer-specific quality of life scores: differences between improvement and worsening. Qual Life Res 11(3):207–221

    Article  PubMed  Google Scholar 

  31. Eton DT, Cella D, Yost KJ, Yount SE, Peterman AH, Neuberg DS, Sledge GW, Wood WC (2004) A combination of distribution- and anchor-based approaches determined minimally important differences (MIDs) for four endpoints in a breast cancer scale. J Clin Epidemiol 57(9):898–910. doi:10.1016/j.jclinepi.2004.01.012

    Article  PubMed  Google Scholar 

  32. Courneya KS, Mackey JR, Bell GJ, Jones LW, Field CJ, Fairey AS (2003) Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. J Clin Oncol 21(9):1660–1668. doi:10.1200/JCO.2003.04.093

    Article  PubMed  Google Scholar 

  33. Nieman DC, Cook VD, Henson DA, Suttles J, Rejeski WJ, Ribisl PM, Fagoaga OR, Nehlsen-Cannarella SL (1995) Moderate exercise training and natural killer cell cytotoxic activity in breast cancer patients. Int J Sports Med 16(5):334–337. doi:10.1055/s-2007-973015

    Article  CAS  PubMed  Google Scholar 

  34. Yuen HK, Sword D (2007) Home-based exercise to alleviate fatigue and improve functional capacity among breast cancer survivors. J Allied Health 36(4):e257–e275

    PubMed  Google Scholar 

  35. Jones LW, Courneya KS (2002) Exercise counseling and programming preferences of cancer survivors. Cancer Pract 10(4):208–215

    Article  PubMed  Google Scholar 

  36. Jones LW, Courneya KS, Fairey AS, Mackey JR (2004) Effects of an oncologist’s recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors: a single-blind, randomized controlled trial. Ann Behav Med 28(2):105–113. doi:10.1207/s15324796abm2802_5

    Article  PubMed  Google Scholar 

  37. Park JH, Lee J, Oh M, Park H, Chae J, Kim DI, Lee MK, Yoon YJ, Lee CW, Park S, Jones LW, Kim NK, Kim SI, Jeon JY (2015) The effect of oncologists’ exercise recommendations on the level of exercise and quality of life in survivors of breast and colorectal cancer: a randomized controlled trial. Cancer. doi:10.1002/cncr.29400

    Google Scholar 

  38. Lanier AB, Jackson EM, Azar-Dickens J, Anderson B, Briggs M (2012) Descriptive assessment of exercise program on fitness and correlates of participation. Am J Health Behav 36(5):647–654. doi:10.5993/AJHB.36.5.7

    Article  PubMed  Google Scholar 

  39. Harris SR (2012) “We’re all in the same boat”: a review of the benefits of dragon boat racing for women living with breast cancer. Evidence-Based Complementary and Alternative Medicine : eCAM 2012:167651. doi:10.1155/2012/167651

    Article  Google Scholar 

  40. Sabiston CM, McDonough MH, Crocker PR (2007) Psychosocial experiences of breast cancer survivors involved in a dragon boat program: exploring links to positive psychological growth. Journal of Sport & Exercise Psychology 29(4):419–438

    Article  Google Scholar 

  41. Ooms L, Veenhof C, de Bakker DH (2013) Effectiveness of start to run, a 6-week training program for novice runners, on increasing health-enhancing physical activity: a controlled study. BMC Public H ealth 13:697. doi:10.1186/1471-2458-13-697

    Article  Google Scholar 

Download references

Acknowledgments

We wish to thank Wheel and Sprocket and Lands’ End for their generous support of our triathlon training program with bicycle gear and swimwear, respectively. In addition, numerous donors help support the professional coaching. Dr. Linda Piacentine, RN, PhD provided helpful comments in the writing of this manuscript. This research was supported by the Aurora Research Institute through its Aurora Cancer Care Research Awards, funded by the Vince Lombardi Cancer Foundation.

Author information

Authors and Affiliations

  1. Program in Exercise Science, Department of Physical Therapy, Marquette University, P.O. 1881, Milwaukee, WI, 53201-1881, USA

    Alexander V. Ng, Alyson N. Cybulski, Ashley A. Engel & Paula E. Papanek

  2. Clinical Analytics, Wheaton Franciscan Healthcare, Glendale, WI, 53212, USA

    Megan A. Sheffer

  3. Cancer Rehabilitation, Department of Physical Therapy, Aurora Health Care, Milwaukee, WI, 53233, USA

    Leslie J. Waltke

  4. Surgical Breast Oncology, Aurora Research Institute, Aurora Health Care, Milwaukee, WI, 53233, USA

    Judy A. Tjoe

Authors
  1. Alexander V. Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alyson N. Cybulski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashley A. Engel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paula E. Papanek
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Megan A. Sheffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leslie J. Waltke
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Judy A. Tjoe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander V. Ng.

Ethics declarations

Written informed consent, approved by the University’s Institutional Review Board, was obtained from each subject to take part in the research.

Conflict of interest

The lead author states that he has no financial relationship with the organization that sponsored the research. At the time of the study, several of the co-authors were employed by Aurora Health Care, the organization that administered the grant for the Vince Lombardi Cancer Foundation. No authors have a financial relationship with the Vince Lombardi Cancer Foundation. The lead author has full control of all primary data that contributed to this study, and it is available for journal review if requested.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ng, A.V., Cybulski, A.N., Engel, A.A. et al. Triathlon training for women breast cancer survivors: feasibility and initial efficacy. Support Care Cancer 25, 1465–1473 (2017). https://doi.org/10.1007/s00520-016-3531-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-016-3531-5

Keywords

Search

Navigation